Expediting Medicaid Coverage for Prison Inmates

Prison system policies can help inmates benefit from Medicaid coverage (mediaphotos/iStock.com.

As many state Medicaid programs expand through the Affordable Care Act (ACA), a new survey indicates that some state prisons could improve prisoners’ health care and lower state spending by revising policies on prisoner enrollment in the state-federal health plan.

The survey, published online today in the American Journal of Public Health, evaluated Medicaid policies from December 2011 to August 2012 at 42 state prison systems. According to the results, 66.7% of the prisons terminated enrollment and 21.4% suspended inmates from Medicaid when they were incarcerated. However, two-thirds of these prisons also helped prisoners reenroll when they were discharged.

“Enrollment improves access to basic health services, including substance use and mental health services, and can in turn benefit the health of the communities and families to which prisoners return,” lead author Josiah Rich, MD, MPH, said in a statement.

Rich and his colleagues questioned the policies to terminate coverage during incarceration as ACA provisions roll out. States with expanded Medicaid programs will cover all adults, regardless of whether they’re disabled or have dependents, up to 138% of the federal poverty level. Broader eligibility means more prisoners likely will be covered. But if their coverage is terminated, prisons can’t benefit from a 1997 federal law that allows Medicaid to cover inpatient care that inmates receive outside of the prison system, as long as they’re Medicaid eligible.

“Although the proportion of prisoners who require inpatient, community care is likely modest, their health care costs may be relatively high,” the investigators wrote. If inmates’ Medicaid coverage is terminated, state corrections departments miss out on federal reimbursement dollars. Officials in only 15 state prison systems submitted Medicaid applications to obtain reimbursement for inmates who weren’t enrolled and received inpatient care away from the prison.

Also, broader eligibility means more released prisoners may be covered. But the survey showed that prisoners whose coverage was suspended weren’t automatically reenrolled, and they faced similar challenges as prisoners whose coverage was terminated and had to reenroll: timing release dates to match effective coverage dates, coordination among state agencies, excessive paperwork, and following through the enrollment process. Even so, coverage usually resumed within a month of release, according to the findings.

The investigators found that two-thirds of the prison systems with termination or suspension systems offered some type of assistance to enroll or reenroll in Medicaid. However, they noted, “the lack of assistance in the remaining [systems] should be addressed, as this constitutes a basic function of discharge planning.”